On Tuesday night PBS FRONTLINE aired an episode about the anti-vaccine movement entitled The Vaccine War (which, by the time you read this, should be available for online viewing in case you missed it). When I first heard that this show was going to air, I was a bit concerned. My concern, of course is what I’m always concerned about when journalists do a story about pseudoscience, be it the anti-vaccine movement, “intelligent design” creationism, various “alternative medicine” modalities, or whatever. We’ve written about such things right here on SBM on more than one occasion, be it Dr. Jay Gordon on The Doctors or Andrew Wakefield being interviewed by Matt Lauer. Although FRONTLINE has done a pretty good, science-based job on controversial topics, I felt some trepidation, particularly after seeing some of the promos for the show, even though it featured Dr. Paul Offit, and other physicians and scientists.

Fortunately, I needn’t have worried. The Vaccine War is not perfect. There are some definite flaws, but by and large it is a rare thing on TV: A science-based discussion of a pseudoscientific movement. True, the opening montage did bring back a bit of that anxiety that this was going to be a “tell both sides” bit of false balance in that it included J.B. Handley blathering and Jenny McCarthy spewing her same false dilemma of measles versus autism. (She’d choose the measles, of course.) I was able to forgive that, because it’s very clear that the producers were just setting up the story. The show then launched straight into a birth and a list of the vaccines that children get, with Melinda Wharton of the CDC and Paul Offit pointing out how much good vaccines do, how we no longer see diseases that once killed thousands or even milions.
Then it was straight to Ashland, OR and the woo, personified by a mother named Jennifer Margulis, a writer for that “natural” repository of woo Mothering Magazine. She wasted no time spewing nonsense about “natural immunity” versus vaccines, claiming that it is better than vaccine-induced immunity. (Yes, it may be more long-lasting, but it comes without the risk of actually getting the diesease.) Dr. Donna Bradshaw-Walters was then introduced, and she described how 28% of Ashland’s children are missing some or all of their vaccines, pointing out that it is only a matter of time before there is an outbreak there. (I wonder how far Ashland is from Portland. Our intrepid fellow SBM blogger Mark Crislip is in the Portland area somewhere.) It was refreshing to note that there are actual pro-vaccine parents in Ashland, one of whom predicted that it would get ugly if there were an outbreak in which vaccinated children started to get sick because of unvaccinated children forming a repository for disease that can spread to vaccinated children whose vaccines didn’t “take,” for whatever reason. The show then described the San Diego measles outbreak and how unvaccinated children are a vector for infection, even to the vaccinated, who are less likely to be infected but not immune, as no vaccine is 100% effective.

Next, there was a segment at Pfizer. This may not have been the best idea strategically, given how it feeds into the distrust of big pharma exhibited by the vaccine fearful, although the scientist interviewed, Dr. Emilio Emini, did a good job of pointing out how vaccines prevent disease. Still, right there, I could envision doubting parents becoming suspicous. Then, of course, there was Dr. Paul Offit, who, although he is the Dark Lord of Vaccination to the antivaccine movement, is nonetheless the one of the most effective provaccine voices. Happily, Offit makes no apologies for having gotten rich from a vaccine. He is enormously proud of it, as he should be. But what he’s proud of is not having gotten rich, but have invented a product that has saved thousands upon thousands of children’s lives. That is truly something to be proud of.

One thing The Vaccine War revealed that I didn’t know was that bioethicist Arthur Caplan had actually contracted polio in his youth. No wonder he is so effective when he argues for vaccines. Equally effective is a scene in which paramedics are being trained, part of their training being to watch videos of children with pertussis and rotavirus. The video of the child with pertussis is horrifying; the suffering of such children is incredible. This class even pointed out that chickenpox can actually be fatal, showing a child with staph sepsis in the pox lesions.

Unfortunately, at this point the aforementioned Margulis demonstrates her extreme ignorance by asking why we are still vaccinating for polio as polio has become more rare. This woman was truly irritating in her arrogance of ignorance. Worse, she kept popping up throughout the show, sadly enough. But that wasn’t enough. There had to be Barbara Loe Fisher, too, spewing her usual anti-vaccine line. Unfortunately, here’s where FRONTLINE fell down on the job. The show actually described BLF not just once, but multiple times, using terms like “vaccine watchdog” or “vaccine safety” advocate, rather than what she is, an anti-vaccine propagandist. Bad FRONTLINE!

Similarly, the interview with Jenny McCarthy was infuriating, as usual. I suppose I should be used to her smug anti-science attitude. Buried in McCarthy’s assault on science and reason, though, there was a rather interesting tidbit. However, you have to go to her complete online interview to find it:

How long after the MMR was that first seizure?

You know, a lot of people think, and probably from me saying in some interviews, that it was after the MMR I noticed changes.

I don’t think it was just the MMR shot that caused any kind of trigger with autism. I think it was a compilation of so many shots to a kid that obviously had some autoimmune disorders. So I would say maybe a couple of months, a month or so after the MMR, I started to notice some physical ailments such as constipation, rashes, eczema. That was like the first little sign. And then the train just kind of descended from there.

This is very different from the stories McCarthy was telling around the time she released her first book, and she even seems to be acknowledging it as she dances around a very simple question. Indeed, I remember McCarthy saying in interview after interview how she saw the “light go out of Evan’s eyes” soon after the shot. That’s why her story resonated with the anti-vaccine movement so strongly, as shown when anti-vaccination activist Ginger Taylor cited what Jenny McCarthy said in her 2007 interview with Oprah:

Jenny says even before Evan received his vaccines, she tried to talk to her pediatrician about it. “Right before his MMR shot, I said to the doctor, “I have a very bad feeling about this shot. This is the autism shot, isn’t it?’ And he said, ‘No, that is ridiculous. It is a mother’s desperate attempt to blame something,’ and he swore at me, and then the nurse gave [Evan] the shot,” she says. “And I remember going, ‘Oh, God, I hope he’s right.’ And soon thereafter-boom-the soul’s gone from his eyes.”

Notice how Jenny appears to have changed her story from its being the MMR to its being a gradual process due to too many vaccines. Truly, her story shifts more than the sands of the Sahara, or the waves of the ocean, or your favorite metaphor for something shifty and lacking substance.

Speaking of shifty and lacking substance, the first Jenny McCarthy segment ran right into an interview with J.B. Handley. There was really nothing new there in that J.B. claims that “tens of thousands” of parents tell him that their children were “never the same” after vaccines, combined with his simplistic mantra: Vaccines cause brain damage and autism is brain injury. Ergo, to him, vaccines cause autism. Of course, it is not really true that autism is “brain injury.” It is a difference in the brain, but there’s no good evidence that autism is primarily due to “brain injury,” although there’s all sorts of quackery out there that purports to treat “vaccine injury” to the brain.

Here’s another point where the FRONTLINE special dropped the ball a bit. The show immediately went into the MMR fear mongering provoked by Andre Wakefield. The problem is that J.B. Handley wasn’t really about MMR, at least not until recently. He was about mercury and thimerosal. Indeed, Generation Rescue until a couple of years ago proclaimed on its website that autism is a “misdiagnosis for mercury poisoning.” (And guess where that mercury exposure came from? That’s right, vaccines.) But the MMR has never had mercury in it, ever. In conflating these issues, FRONTLINE confused two related issues that are not really the same thing, particularly when it started showing a speech by Robert F. Kennedy, Jr. at the Green Our Vaccines rally from two years ago. As someone who knows about the anti-vaccine movement and its history, this was irritating, and it is more than just a nit to pick.

That being said, I do like how, right after a segment in which Jenny McCarthy claims that scientists won’t study whether vaccines cause autism, the show immediately launched into a segment that demonstrated conclusively that that she is either mistaken or lying (take your pick). The issue has been studied extensively in multiple countries, and no link between vaccines and autism has been found. Thus, right after McCarthy made a claim, the claim was demolished totally. Moreover, FRONTLINE did a good job of explaining how correlation does not necessarily mean causation. Just because a diagnosis of autism is made soon after a vaccine does not necessarily mean the vaccine caused autism. It finished this middle part of the documentary by documenting the fall of Andrew Wakefield, in particular pointing out how some of the children in his studies had been referred through lawyers suing vaccine manufacturers.

The beauty of this segment is how FRONTLINE showed that, no matter how much evidence, with J.B. Handley saying, “I don’t give a fuck about what the MMR study said.” (Yes, he did use the F-word, although it was bleeped out and turned to “crap” in the online transcript. Stay classy, J.B.) This was rapidly followed by a demonstration of Barbara Loe Fisher shifting the goalposts asking for more epidemiological studies and basic science studies. It is, as Dr. Offit put it, a classic shifting of goalposts, with Jenny McCarthy blathering about her “mommy warriors” and how “Evan is her science.” In fact, I particularly liked how Dr. Offit explained exactly how the anti-vaccine movement is constantly shifting the goalposts in a way that a lay peson could understand.

Unfortunately, this segment depressed me, because it showed just how much science doesn’t matter in trying to persuade these parents and how the web perpetuates not just the old vaccine myths, but facilitate the spread of new ones. It demonstrates just how much the Internet’s “democratization” of knowledge devalues knowledge, expertise, and science. The forces of pseudoscience proliferate and infiltrate, and, quite frankly, those of us who promote science-based medicine are way behind the eight ball in trying to counter these messages. One thing I had no idea about was just how effective the Desiree Jennings story had influenced high school students not to vaccinate. Roughly half of one class who hadn’t taken the H1N1 vaccine said that the reason they didn’t take the vaccine was because they saw Desiree Jennings on YouTube. This makes me think, more than ever, that blogs such as this one and others are essential in tearing apart such bad information. The result of this information is people like the mothers in Ashland that I discussed last time who ask, “If vaccines work, who am I hurting by not vaccinating?”

The result was shown in the story of a baby who came down with pertussis and almost died. Her situtation was so bad that a chaplain was brought in for possible last rites.

Near the end of the show, there was presented a focus group of people who discussed vaccination. What was interesting is how much vaccination is viewed as a parental choice rather than a societal duty. This in and of itself is not necessarily a bad thing. It’s completely consistent with the psyche many people in the U.S. and the principles of limited goverment and self-reliance. The problem is that this choice is being increasingly undermined by misinformation on the Internet and elsewhere in the media. The message of the anti-vaccine movement that the days of “paternalism” are over echoes very strongly with the whole “health freedom” movement. The problem with this “freedom” is that refusing vaccination endangers more than just the child of the parent making the choice. It endangers other children, vaccinated or unvaccinated. It’s very difficult for anyone to make a well-informed choice when most of the information that pops up when you search the Internet is from the anti-vaccine side.

In the end, I was mostly relieved by The Vaccine War. It was science-based, and it pulled no punches in asserting that there is no good scientific evidence that vaccines cause autism. True, it did confuse the issue of the MMR vaccine and thimerosal-containing vaccines, and that’s more than a minor mistake. It also failed to address the valid reasons why we vaccinated for hepatitis B to neonates. Worse, it was far too kind in its treatment of Barbara Loe Fisher, calling her organization, the National Vaccine Information Center a “vaccine safety” advocacy organization, when it is an anti-vaccine organization, plain and simple. It did a little better with Generation Rescue, showing a bit of the sheer insanity behind the organization and how, no matter how much evidence there is against its position, it never loses sight of its founding principle, namely that it’s absolutely, positively always the vaccines. Always. Those complaints aside, FRONTLINE did a far better job than I expected in deconstructing the anti-vaccine movement. It didn’t compromise on the science, although it may have compromised a bit in how it describes, for example, the NVIC and Generation Rescue.

Will The Vaccine War change minds? Maybe. There’s no way it’s going to change the minds of hard core antivaccinationists of J.B. Handley’s ilk. Almost nothing I can think of can. But it might–just might–reassure parents on the fence that all that horrible stuff they’re hearing on the radio, seeing on TV, and, above all, reading on the Internet about the evils of vaccines are not based in science. That’s actually quite an achievement.

ADDENDUM: There was a segment in which a pro-vaccination parent in Ashland was profiled. In a shot in which she was surfing the ‘net, guess what blog showed up?